Munchausen syndrome and Munchausen syndrome by proxy: a narrative review.

Daniel de Sousa Filho,Alfredo Maluf Neto,Elton Yoji Kanomata,Ricardo Jonathan Feldman

doi:10.1590/s1679-45082017md3746

Daniel de Sousa Filho, Alfredo Maluf Neto + Show 2 more

Open Access

https://doi.org/10.1590/s1679-45082017md3746

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Abstract

ABSTRACTThe Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.

Highlights

The term “Munchausen syndrome” was first described in 1951 by Asher[1] to characterize individuals who intentionally produce signs and symptoms of a disease and who tend to seek medical or hospital care
Our study reviews the literature about Munchausen syndrome and Munchausen syndrome by proxy
This is a narrative, non-systematic review including case reports, series of case reports, and reviews indexed in PubMed from the first paper published on this subject in 1951 to November 2015

Summary

INTRODUCTION

The term “Munchausen syndrome” was first described in 1951 by Asher[1] to characterize individuals who intentionally produce signs and symptoms of a disease and who tend to seek medical or hospital care. 2017;15(4):516 disorder must appear when any combination of the following factors is seen in a hospitalized patient: atypical presentation that is not classified as a general medical condition or an identified mental disorder, symptoms or behaviors present only when the individual is being observed, pseudologia fantastica, atypical behavior at hospital wards (e.g., disobedience to hospital rules and excessive arguing with health professionals responsible for the care), unusual grasping of medical terminology and hospital routines, hidden use of substances, evidence of multiple treatments (e.g., multiple surgeries, repetitive courses of electroconvulsive therapy), a history of extensive travels, few or no visits during hospitalization, fluctuating clinical course, and rapid development of “complications” or new “disease” in patients who initial investigation was negative. It should be emphasized that most of the treatments reported in case studies or literature reviews were conducted in hospital settings, with few weeks or months of treatment, which could be an important bias in these studies.[7,8,9]

DISCUSSION

CONCLUSION